Systemic tetracyclines in the treatment of noninfected corneal ulcers: a case report and proposed new mechanism of action.

Corneal melting refers to a condition in patients whose corneas undergo progressive necrosis of stromal tissue despite being culture negative. Recent evidence has shown that systemic tetracyclines demonstrate anti-collagenolytic activity that may have clinical effectiveness in disease treatment. The evidence led us to try this modality as adjunct therapy in the treatment of an 80-year-old white man with a noninfected corneal ulcer. One gram of tetracycline in four divided doses led to a dramatic resolution of the corneal ulcer. This positive result supports the new concept that tetracycline therapy inhibits tissue collagenolytic enzyme activity by a mechanism unrelated to its antibacterial efficacy and may prove useful in the treatment of nonspecific corneal ulceration.